What Is an Out-Of-Pocket Maximum?

With any health insurance plan, you’ll be responsible for paying a percentage of your health care costs. But your health plan will also put a cap on the total amount you have to pay. This is called an “out-of-pocket maximum.”

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For example, it’s common to have a 20% copayment for hospital care. A quick visit might cost $100 — and that means you’re only paying $20. But what if you needed serious care and your hospital bill came to $100,000 dollars? Now you’re looking at $20,000… and that’s a lot of money for most people.

Fortunately, your out-of-pocket maximum — or OOP — will keep you from having to fork over that much money to the hospital. Most health plans set your OOP at a few thousand dollars. So instead of owing $20,000, you might owe just $2,000. Your health plan’s out-of-pocket maximum can mean the difference between affording medical care and having a lifetime of debt.

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